Affiliation:
1. University Hospital Leipzig
2. Hospital Torgau
3. HELIOS Vogtland–Klinikum Plauen
4. Hematology Practice
5. Klinikum Oberlausitzer Bergland
6. Asklepios Klinik Weißenfels
7. University of Leipzig
Abstract
Abstract
Introduction:
Autologous stem cell transplantation (ASCT) is the standard first line treatment for younger patients with multiple myeloma (MM). Bortezomib and bendamustine have both been identified as rapidly acting and well-tolerated drugs for patients with MM-induced renal failure. In this retrospective study we analyzed the efficacy of induction therapy with a combination bendamustine, prednisone and bortezomib (BPV) prior to ASCT in newly diagnosed MM-patients (NDMM) depending on severity of renal impairment.
Methods
135 patients with NDMM were treated with BPV-induction.
Results
The majority of patients (n = 117; 87%) responded after BPV-induction with 9 sCR, 3 CR, 12 nCR, 39 VGPR, and 54 PR. After first ASCT ORR increased to 99% with 33 sCR, 10 CR, 32 nCR, 41 VGPR and 17 PR. Median PFS was 47 months and OS at 60 months was 67%. Patients were divided into four groups depending on severity of renal impairment: A (n = 13) with eGFR < 15mL/min, B (n = 15) 15–29mL/min, C (n = 19) 30-59mL/min and D (n = 88) ≥ 60mL/min. We observed no significant difference in PFS between patients with normal/mild, moderate, severe renal dysfunction and renal failure/dialysis (50 vs 47 vs 34 vs 24 months, p = 0.05) and in 60 months OS (69 vs 72 vs 58 vs 70%, p = 0.23). The renal response rate improved from 61% after BPV to 74% following ASCT.
Conclusions
These results indicate that BPV-induction followed by ASCT is feasible, effective and well tolerated in patients with MM-induced renal failure. Furthermore, we showed that pretreatment with short-term bendamustine had no negative impact on stem cell mobilization.
Publisher
Research Square Platform LLC
Reference46 articles.
1. Altekruse SF, Kosary C, Krapcho M, Neyman N, Aminou R, Waldron W (2011) SEER cancer statistics review 1975–2007, National Cancer Institute, Bethesda. http://www.seercancergov/csr/1975- 2007. Accessed March 10, 2011
2. Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma;Attal M;N Engl J Med.,2017
3. Extending autologous transplantation as first line therapy in multiple myeloma patients with severe renal impairment: a retrospective study by the SFGM-TC;Augeul-Meunier K;Bone Marrow Transplant.,2018
4. Phase II study of bendamustine, bortezomib and dexamethasone (BBD) in the first-line treatment of patients with multiple myeloma who are not candidates for high dose chemotherapy;Berdeja JG;Br J Haematol,2017
5. Effect of High-Cutoff Hemodialysis vs Conventional Hemodialysis on Hemodialysis Independence Among Patients With Myeloma Cast Nephropathy: A Randomized Clinical Trial;Bridoux F;JAMA.,2017